A Mental Game: Pain

(Author’s note: It’s that time of year again where I’m preparing to teach several sections of Intro Psychology, so I thought I’d try to combine purposes and put something together drawing on the section addressing sensation and perception. It is apropos of nothing in particular, but does fit with my occasional series on ‘a mental game’ where I’ve written about sports psychology, group conflict, and happiness.)

After an eventful World Cup that likely cost him the first few months of the new club season, how does Holland’s Arjen Robben feel? I mean that quite literally—I’m not looking for the sideline reporter’s sports clichés, nor the armchair philosopher’s curiosity about what it means to lose a World Cup final. I want to know about the experience of pain. Because Robben’s antics during the World Cup were strangely infuriating. His dramatic facial expressions prompted by any ordinary challenge, his excruciating gesticulation at the mere hint of physical contact, his anguished complaints to anyone that would listen. It seemed cheap and tawdry—and it reinforced all the superficial critique of soccer-critics who can’t get beyond the perceived dishonor of ‘flopping.’ In a certain odd way, his claims of pain became a litmus test for how we think about the game.

So while my curiosity about pain goes well beyond any one individual case, Robben is particularly interesting because he takes a lot of guff for the way he puts his pain on display. As Richard Farley noted in a World Cup preview:

“Robben is one of the world’s most dangerous players when he marauds down the right hand flank. However, he comes with some baggage as well – he’s notorious for inviting contact from the opposition and going down too easily, as well as missing far too many games to knocks and niggles. Perhaps he simply has an unusually low pain tolerance?”

While that question was probably sarcastic, it does tap a real issue in the game. What is pain worth?

Because as it turns out Robben really was playing with a serious injury: his ‘knocks and niggles’ in the World Cup were serious enough to require surgery. And it turns out that for any player in any sport, because of the nature of pain, we can never exactly know how they feel: the physical pain that is so much a part of competitive sports is less an objective biological reality than a subjective psychological experience.

The psychology of pain

Towards the end of my competitive playing days, pain was a very real part of my own psychological experience in the game. I was in my twenties, my body was resilient and well-conditioned, and I was fortunate to avoid any ‘serious’ injuries. But I still woke up nearly every day with gnawing aches shooting through limbs, joints, muscles, and tendons; the hurt was enough to contribute to my decision to give up my soccer-playing dreams (a decision heavily facilitated by the fact that I wasn’t quite good enough). It also made me wonder about the fact that when top-level players retire we respect them for saying they want to move on to new challenges, to spend more time with their families, that they’ve accomplished all they wanted to accomplish. But we don’t want to hear that it hurts too much.

Why not? Isn’t pain a physical experience that we can’t do anything about? Pain is the body’s way of telling us something is wrong: at a base physiological level there is some kind of damage that triggers neural signals demanding remediation. It’s not me—it’s my body. Right?

Yes and no. Pain, like any human perception, derives from a combination of physical signals and psychological responses. In fact, in psychological science sensation and perception are meaningfully different phenomena: the physical sensation triggered by a stimulus out there in the world is different from the ultimate psychological perception inside our minds (by wilson santiago). Psychologists who study sensation and perception talk about this difference as related to efficiencies of the human brain: to avoid having to match and record every one of the millions of available bits of sensory information the brain combines “bottom-up” processing of basic data out in the world with “top-down” processing based on concepts and expectations already programmed (by genetics and experience) in our minds. When Arjen Robben walked into the stadium for the World Cup final his brain immediately started processing millions of stimuli—blades of grass, specks of white paint, swarthy millionaire Spaniards—but his brain’s well-honed expectation of what a pitch should look like, along with an innate ability to recognize broad spatial patterns, eliminated the need to process every detail (leaving plenty of time to jealously contemplate Carles Puyol’s flowing locks).

I actually find it easiest to make sense of this concept through examples from visual perception. Optical illusions are perfect examples because they highlight the way the brain adds to and subtracts from the raw visual information in any one scene. In the lower left corner illustration on the right (which I found at boredville.com—though I don’t know who to credit for its creation), it is nearly impossible for us to perceive the three elephants trailing away in a single file line as being the same size, even though sensation of the images on our retina are exactly the same size (go ahead, measure): our experiences with depth perception tell us to add size to things that are further away. The “bottom up” processing of the image on our retina negotiates with the “top down” processing of our memory.

It’s also worth noting that while the inclusion in this illustration of Frank Lampard’s infamous “goal” against Germany from the World Cup is clearly intended as a joke, it is not completely irrelevant to the psychological process of sensation and perception. Presuming the referee and his assistant on the line had a clear view of the goal area for that fateful shot, the image that hit their retinas presented their brain with the raw data of a ball crossing a line. But that information came so quickly that the brain automatically executed a cross-check using concepts and expectations—based on the way the ball bounced, the reaction of the goalkeeper, the angle of the strike, it seemed an improbable goal. Unconsciously, automatically, and even (in the grand scheme of things) efficiently, the decision was to play on. Seconds later, with the benefit of slow-motion replays and still shots that presented irrefutable “bottom-up” data, the soccer world had no more need for “top down” processing and knew the referee had made a dramatic mistake. But such is the magnificent design of a human brain (and the inevitable limitation of a human referee).

Something similar happens with pain. When a player such as Arjen Robben is knocked to ground on a tackle, the contact does inflict minute degrees of tissue damage. That damage, potentially enhanced by increased physiological sensitivity residual from prior injury, results in signaling through the central nervous system that activates the brain: there is a bottom-up sensation. But the brain simultaneously offers an interpretation of that sensation which depends heavily on context: Robben’s expectations and his schema for how to deal with a sloppy challenge initiate a top-down process. His eventual perception, deriving from both these processes, is ultimately his own subjective experience—it has surprisingly little to do with the objective severity of the tackle.

But wait, you might ask, don’t many other types of direct stimuli (ie, other sloppy challenges) result in much more reasonable perceptions of pain? Didn’t Xabi Alonso take the full brunt of the unrepentant leg-breaker Nigel De Jong’s studs to his chest with little noticeable effect? Yep. That’s the point: context matters. It matters so much that it can actually change our experience of pain.

There are, for example, studies that measure brain activity using Magnetic Resonance Imaging (MRI) to show that when volunteer subjects expected a moderate level of heat to be applied to their leg, but actually receive an application of extreme heat, their perception of pain is diminished by a degree equivalent to a dose of morphine (compared to when subjects both expected and received extreme heat—in a 2005 study by Koyama et al.). Expectations also seem to cause the body to release its own natural pain relievers, including the same endorphins you hear about in association with exercise, further modifying subjective experiences of pain. And then something as simple as distraction can further decrease pain—in one British study at Keele University, subjects who swore repeatedly were able to keep their hands submerged in ice water for longer than subjects who repeated innocuous words. Various combinations of these factors likely explain how someone like Ike Opara was able to play 90 minutes for the San Jose Earthquakes without realizing that at some point he had broken his foot so badly as to require surgery. That had to hurt.

The sociology of pain

The factors that influence pain perception also allow for the possibility that Xabi Alonso is just a tougher S.O.B. than Arjen Robben—and that is certainly what generations of coaches would like you to believe. The culture of competitive sports generally is one which tends to assume that coping with pain is essential to the toughness required for success. This is often associated with stereotypical notions of masculinity—when male athletes in American and British sports cultures respond flamboyantly to pain it doesn’t take long for them to be told to “man up” or, alternatively and more pathetically, to “take off their dress” (or worse). It turns out, however, in some situations women have a higher pain tolerance than men—and that men seem more extrinsically motivated in the ways they cope with pain. Though research does suggest that on average men seem to have a higher tolerance for acute pain than women (with considerable individual variation), much of that tolerance is likely to be a self-fulfilling prophecy: stereotypical masculinity involves not showing pain, a social pressure which triggers the top-down processes that shape our perceptual experiences.

So when soccer-critics react to the “flopping” in soccer as a lack of toughness, they are failing to appreciate how much context matters to the experience of pain. The fact that sports such as American football, a home base for many soccer-critics, thrive on the idea that pain is noble may actually shape players’ psychological perceptions. Not coincidentally, it may also contribute to things like playing through concussions and suffering long-term brain damage. The absurdity of this dynamic is evident in an essay on “Pigskin, patriarchy, and pain” by sociologist Don Sabo:

“My high school coach once evoked the pain principle during a pregame pep talk. For what seemed an eternity, he paced frenetically and silently before us with fists clenched and head bowed. He suddenly stopped and faced us with a smile. It was as though he had approached a podium to begin a long-awaited lecture. ‘Boys,’ he began, ‘people who say that football is a ‘contact sport’ are dead wrong. Dancing is a contact sport. Football is a game of pain and violence! Now get the hell out of here and kick some ass.’ We practically ran through the wall of the locker room, surging in unison to fight the coach’s war. I see now that the coach was right but for all the wrong reasons. I should have taken him at his word and never played the game!”

Ultimately, in comparison to American football, I think the meaning of pain in world football is a bit more complicated. In fact, I suspect that if you put injured American football players and injured soccer players into studies such as those I’ve described, you’d find that the soccer players do—on average—experience more pain from less physical trauma. Their top-down expectations, the cultures of each game, are just too different. But that doesn’t mean the soccer players are ‘soft’—I suspect some of the anguished responses that appear to be ‘flopping’ actually produce pain in the brain (though I’m not so naïve as to think all of them do; sometimes you just need to hold on for a point on the road, or draw that second yellow).

The comparison with American football also highlights a large piece of what fascinates me about the brain using both top-down and bottom-up processing to create our psychological experience: at the opposite pole from pain, our joy is also crafted by negotiations between what is actually out there in the world and what we’ve come to expect. Though American football fans and world football fans often debate which sport people should enjoy, from the bottom up all sports offer some basic aesthetic pleasure. There is artistry and drama both in the pinball ferocity of a long touchdown run and in the weaving tightrope flow of a pacey winger. Both American football and world football offer the possibility of pleasure with their pain. But which we prefer has much to do with our top-down concepts and expectations—what our brain has come to appreciate.

And the same probably applies to that conniving thespian Arjen Robben. Whether or not his dramatics are born of ‘real’ pain, as fans our sympathy depends less on his physical experience than on our own psychology. We can never know the exact reality of how Robben himself feels; all we can really know is how we as fans feel about him.

we like to watch the play but every position in the game maybe a brain damage for them and that s very bad..

August 27, 2010 at 9:18 amTimoteo

Andrew, I have to disagree with you a little on this one. I believe that most professional soccer players play through as much pain as most football players. Except for very serious injuries, soccer players are EXPECTED to play through pain, because they can’t be substituted for a short period of time to work it out on the bench and the limited number of subs per game means that subbing for an injury that they might be able to play with severely effects a team’s options. The misconception that soccer players are whimps because they flop around a lot after they are tackled comes from not understanding that the players (most of the time) are NOT hurt and DON’T really feel pain. ITS ALL PLAY ACTING. And what’s more, players have to do it to get a call these days. How many times have you seen a player try to stay on his feet in the penalty box after being fouled and not get the call they should have gotten? I’ve seen it a lot. So players flop and roll to draw a penalty, not because they feel pain. That’s why they hop up immediately and run back on the field after getting the call! What I explain to my friends who don’t understand this dynamic in the sport: call soccer players flamboyant actors and abhor that part of the game (as I do) but don’t mistake that play acting for being “sissies” because soccer players are tough who constantly play through a lot of pain.

August 27, 2010 at 9:35 amKent

Of course professional soccer players play through pain and fatigue. While I agree that soccer is more grueling and has more contact than its (largely American) detractors claim, there is no way soccer players are playing with and through the injuries and pain that American football players deal with each day.

I’ve been a soccer fan since long before it was even a niche sport in the USA and I love the game to this day. That said, the flopping around drives me absolutely crazy. I disagree that players “have” to feign injury or sniper wounds to get calls. There’s playing up contact through gamesmanship and there’s the grossly obvious (i.e. EVERYONE sees it!) flopping. The latter could absolutely be minimized by referees not putting up with it–example, Argentine player falls and pretends his leg is broken, stops play, exits field giddy for a water break, asks to come right back on…ref to player? stern warning not to do that again or yellow card–or, cringe everyone, video replay post game where deadly sniper shots are punished with fines or cards. Most players play the game upright and honestly; some (like Robben) need to learn that flopping really is unacceptable.

August 28, 2010 at 5:15 amFootball Souvenirs

Pro players miss more matches through injuries as they have doctors and phsyios advising them when not to play. park footballers like us don’t ahve that so play as long as we can walk normally!!

August 28, 2010 at 9:49 amTimoteo

Kent, You miss my point. You say, ” I disagree that players “have” to feign injury or sniper wounds to get calls. There’s playing up contact through gamesmanship and there’s the grossly obvious (i.e. EVERYONE sees it!) flopping. The latter could absolutely be minimized by referees…” It COULD be but it ISN”T. As long as refs don’t call what they see but what is the APPARENT result (the flop, which is how they call it now) flopping will continue. My point is that flopping and rolling around is not because the players are in pain, but because it gets them calls. You actually back it up with your premise that it would go away as soon as the refs changed the way they call the game. If it wasn’t a function of how the game is called and actually a function of players actually feeling pain, then changing how the game is called would not change those players behaviour. As far as football players playing with more pain, have you ever PLAYED serious soccer? Let me tell you, I played both soccer and football at a reasonably high level. While there’s no doubt there is more violent contact in football, you are wrong about football players playing through more injury and pain then soccer players. Both suffer a lot of knocks, bruises, sprains. Soccer players don’t have the luxury of going off for 20 minutes to shake it off while a sub takes over temporarily.

August 28, 2010 at 1:56 pmKent

Yup–and I appreciate the implication that if I hadn’t played soccer, I somehow wouldn’t understand injury thresholds– and I still disagree with you. I don’t think you make radical points or anything, but I disagree with what you’re saying.

August 28, 2010 at 5:42 pmAndrew

The question of whether American football or world football/soccer players have different pain thresholds is an interesting one that could actually be tested with a well-designed study. But I’ve never come across anything that does that–the closest I’ve seen is a study comparing serious dancers (who have to cope with a lot of injuries) with non-dancer peers, finding that the women dancers were something like three times more tolerant of pain than non-dancers (there was also some difference for men, but it was not nearly as great). The general point, however, fits with my general point–socialization and experiences matter in our tangible experiences of pain. That’s why I speculated American football players might actually feel more pain–the whole culture is oriented to valorizing pain in a way that is not as true for soccer. That’s not to say soccer doesn’t involve or require significant pain tolerance–it does (and, as I noted in the piece, at the end of my playing days the constant pain was a major factor in my daily life). But it’s an interesting (and certainly debatable) question.

The flopping issue is also related, but I see it as slightly different. I probably don’t even have it clarified enough in my own mind–it is, of course, obvious that many times players are just play acting. That’s also kind of an interesting phenomenon (I’ve long had an idea for a piece about the “dramaturgy of injury time”), but the reason I brought it up is because I suspect it relates to pain experiences by being part of the socialization environment. It creates a context, however much everyone knows its fake, where showing pain is temporarily acceptable. Based on the nature of sensation and perception, I suspect that matters. But it’s another empirical question….

October 5, 2010 at 4:45 pmRLT

I love both sports, but I think it’s safe to say that American Football is more physically punishing than World Football when comparing average career lengths & number of games played by top players in each sport. Does that make AF a “tougher” sport? Probably, but who cares? There are risks in both. In AF players put their entire bodies in harm’s way repeatedly. In WF players’ lower bodies are more vulnerable to injury whenever they touch the ball.

Comparing the toughness/pain-threshholds between players of each sport is more difficult, and varies from player to player. Immobilizing injuries such as leg-breaks, sprained ankles & pulled hamstrings etc occur in both sports and players from both sports will react to them in much the same way. (ie Stay down and wait for assistance/stretcher).

Common knocks and bruises however are where we see more difference. I think AF players go into each game expecting to take a physical beating. They’re expected to shake off one big hit after another, and will often try to hide injuries an opposing team could exploit. The hits are legal and part of the game so there’s no point selling anything to a referee. Adrenalin also helps them through it.

In WF, I’m not sure if players go into games expecting to get tackled even once. Based on their reactions from when it happens, it would seem like they do not. They either protest or or try to sell an injury to an official. The contact is usually illegal and the ref has an arbitrary decision to make, which could drastically change a game. As the degrees of reaction vary so dramatically from region to region, I can only conclude that the reactions are more a function of opportunism, culture and respect for officiating rather than that of genuine pain. (A comparison of officiating and general respect for officials between AF & WF players might be worthy of another essay atogether)

In fairness to WF players though, it is usually their feet and legs (their primary tools) that are violated, so I can forgive them for some extra sensitivity. A bit like AF people forgive a QB for getting prissy when taking a knock on their throwing hand/arm. And generally, I think the WF players will “man up” and play through the pain as long as their performance holds up.

Hell, sometimes it’s as simple as the little knocks stinging the most. I could stub my toe on the corner of my bed 100 times…… I’ll go to ground each time.